Residents' experiences of paternalism in nursing homes.

BACKGROUND: Interest in strengthening residents' autonomy in nursing homes is intensifying and professional caregivers' experience ethical dilemmas when the principles of beneficence and autonomy conflict. This increased focus requires expanded knowledge of how residents experience decision-making in nursing homes and how being subject to paternalism affects residents' dignity. RESEARCH QUESTION/AIM: This study explored how residents experience paternalism in nursing homes. RESEARCH DESIGN: This study involved a qualitative interpretive design with participant observations and semi-structured interviews. The interpretations were informed by Gadamer's hermeneutics. PARTICIPANTS AND RESEARCH CONTEXT: Eleven residents were interviewed after a period of participant observation in two nursing homes. ETHICAL CONSIDERATIONS: The study was performed in accordance with the Helsinki declaration. The Regional Ethics Committee (REK) permitted the researcher to perform participant observation in the nursing homes. The use of audio recordings of interviews was registered and supervised by Sikt - Norwegian Agency for Shared Services in Education and Research. The resident's consent was assessed continuously. Three interviews were terminated for ethical reasons. FINDINGS: The resident interviews revealed that residents found it obvious for caregivers to possess the decision-making authority in nursing homes. When residents explained their views, three main themes emerged: (1) To be included even though caregivers make the decisions, (2) Surrender to dependency, and (3) Adherence to nursing home norms. CONCLUSIONS: Residents submit to their caregivers and give caregivers the responsibility and function as leaders. Paternalism was experienced as dignifying in situations where it contributed to residents being able to live according to second order desires and values, and when it implied respect and appraisal of residents' capabilities. Paternalism was experienced as debasing when residents felt left out, and when residents felt that their capabilities were underestimated. This also included their capability to withstand paternalistic influence.

Strategies to manage cognitive dissonance when experiencing resistiveness to care in people living with dementia: A qualitative study.

AIMS: To explore the experiences of healthcare personnel when they face resistiveness to care in people living with dementia in nursing homes. DESIGN: The study has a qualitative explorative design. METHODS: Three focus group interviews were conducted in June 2019. A total of 16 nurses and other healthcare personnel employed in three different nursing homes participated. A semi-structured interview guide was used during the focus group interviews. Data were transcribed verbatim and analysed using an inductive qualitative content analysis. RESULTS: The analysis generated one overarching category-'Tension when facing resistiveness to care', which describes the discomfort healthcare personnel experienced when confronted with resistiveness to care in people with dementia-and two other categories: 'Attitude change' and 'Changing behaviour', which describes their strategies to reduce and/or manage the discomfort. Four subcategories-'Changing the mindset', Conceptual shift', Stepping back' and 'Not giving up'-described the actions taken by healthcare personnel to manage or reduce their cognitive dissonance. CONCLUSION: The strategies used to manage or reduce cognitive dissonance provide a new understanding of how healthcare personnel choose to approach resistiveness to care in people living with dementia. IMPACT: This study addresses cognitive dissonance, a discomfort experienced by healthcare personnel when facing resistiveness to care from people living with dementia. To reduce their dissonance, the participants employed several strategies, including coercive measures, when providing care. The theory of cognitive dissonance may help explain why healthcare personnel sometimes choose to employ coercive measures while providing care.

Nudging in nursing.

Nudging is a concept in behavioural science, political theory and economics that proposes indirect suggestions to try to achieve non-forced compliance and to influence the decision making and behaviour of groups and individuals. Researchers in medical ethics are currently discussing whether nudging is ethically permissible in healthcare. In this article, we examine current knowledge about how different decisions (rational and pre-rational decisions, major and minor decisions) are made and how this decision-making process pertains to patients. We view this knowledge in light of the nursing project and the ongoing debate regarding the ethical legitimacy of nudging in healthcare. We argue that it is insufficient to discuss nudging in nursing and healthcare in light of free will and patient autonomy alone. Sometimes, nurses must take charge and exhibit leadership in the nurse-patient relationship. From the perspective of nursing as leadership, nudging becomes a useful tool for directing and guiding patients towards the shared goals of health, recovery and independence and away from suffering. The use of nudging in nursing to influence patients' decisions and actions must be in alignment with the nursing project and in accordance with patients' own values and goals.